[Surgical treatment of hiatal hernia complicated by short esophagus: a prospective study]. / Khirurgicheskoe lechenie gryzh pishchevodnogo otverstiya diafragmy, oslozhnennykh korotkim pishchevodom.

OBJECTIVE: To analyze immediate and long-term postoperative results in patients with hiatal hernia complicated by short esophagus. MATERIAL AND METHODS: We prospectively analyzed postoperative outcomes in 113 patients with hiatal hernia who underwent surgery between 2013 and 2021. The main group consisted of 54 patients with length of intra-abdominal segment of esophagus <4 cm who underwent Collis procedure or esophagus >4 cm and indications for Nissen fundoplication cuff. The control group consisted of 59 patients and indications for esophageal lengthening procedure only if length of intra-abdominal segment of esophagus was less than 2 cm. This surgery was started with anterolateral vagotomy, and Collis procedure was performed in case of ineffective vagotomy. Nissen fundoplication was performed for abdominal segment of esophagus >2 cm. RESULTS: In the main group, 17 (31.5%) patients with intra-abdominal segment of esophagus <4 cm required Collis procedure. In the control group, length of intra-abdominal segment of esophagus <2 cm was observed in 6 (10.2%) patients. In all cases, anterolateral vagotomy was performed. Surgery time was 189 (80-290) and 136 (90-320) min, respectively (p=0.001). Postoperative complications in the main group occurred in 8 (14.8%) patients, in the control group - 4 (6.8%) patients (p=0.281). One (1.7%) patient died in the control group. The follow-up period was 38 (12-66) months. In long-term period, recurrence developed in 2 (3.7%) and 11 (20%) patients, respectively (p=0.026). High satisfaction with postoperative outcomes was observed in 51 (94.4%) and 46 (79.3%) patients, respectively (p=0.038). CONCLUSION: Uncorrected shortening of the esophagus can be one of the main risk factors of recurrence in long-term period. Expanding the indications for Collis gastroplasty can reduce the incidence of poor outcomes without affecting the incidence of postoperative complications.

[Collis gastroplasty in surgical treatment of hiatal hernia]. / Primenenie gastroplastiki po Kollisu v khirurgicheskom lechenii gryzh pishchevodnogo otverstiya diafragmy.

OBJECTIVE: To analyze the early and long-term postoperative outcomes after Collis gastroplasty in the treatment of patients with hiatal hernia complicated by gastroesophageal reflux disease and shortening of the esophagus. MATERIAL AND METHODS: Postoperative outcomes after Collis gastroplasty were analyzed in 22 patients with hiatal hernia and shortening of the esophagus. The control group consisted of 166 patients after simple repair of hiatal hernia without Collis procedure. RESULTS: In case of Collis gastroplasty, surgery time was 185 (160-250) min. Intraoperative complications were observed in 3 (13.6%) patients, incidence of postoperative complications - 18.2%. There were no lethal outcomes in this group of patients. Mild functional dysphagia was observed in 2 (9.1%) patients. Length of hospital stay was 7.8±2.4 days. Mean follow-up was 34 (6-52) months. There were no anatomical recurrences. A relapse of gastroesophageal reflux was noted in 1 (4.6%) case. GERD-HRQL score was 4.8±2.2 points. Additional Collis gastroplasty did not affect the immediate and long-term results of surgical treatment in comparison with simple cruroraphy and fundoplication. CONCLUSION: Unreduced shortening of the esophagus may be followed by high incidence of recurrent hiatal hernia and GERD in long-term period. In case of shortening of the esophagus, surgery should include Collis gastroplasty. This effective and safe procedure does not impair treatment outcomes. Indications and optimal technique of Collis gastroplasty require clarification and further research.

[Simultant operative interventions for diseases of the colon and other abdominal organs].

In the clinic of general surgery, basing on surgical department No 2, for the 2012 - 2013 yrs period 469 patients were operated for the large bowel diseases (LBD). In 60 (12.8%) patients in LBD and concomitant diseases of abdominal cavity simultant operative interventions (SOI) were performed. Rate of postoperative complications have constituted 15%. All the patients are alive. Performance of SOI, not depending from duration and significant volume of the operative intervention, we consider optimal and feasible, because the complications rate in the patients did not differ trustworthy from such after a standard operative interventions.

[Laparoscopic and NOTES endovideosurgical interventions for colonic diseases].

Peculiarities of learning period and results of endovideosurgical interventions in colonic diseases were analyzed. In 72 patients laparoscopic technology was applied, in 5-transanal endomicrosurgical (TEM) rectal resection for various colonic diseases, including 67 (87%)--for colorectal cancer. Complications have had occur in 9 (11.7%) patients. All the patients are alive. There was no need for formation of unloading or protective stoma. Performance of endovideosurgical operations in colon diseases is expedient because of their lesser traumaticity, reduction of a stationary treatment period and the need for diagnostic and treatment measures postoperatively.

[Multivariate analysis of risk factors of the anal functional disorders after abdominal-anal resection with delayed formation of colonic-anal anastomosis].

Multivariate analysis of clinical factors was conducted on the material histories of 195 patients treated between 2004 and 2006. In Donetsk regional antitumor center, which for rectal cancer (RC) is made abdomino-anal resection of the rectum with the delayed formation koloanal anastomosis after bringing down the colon to the perineum. In 97 patients the operation was performed with the use of electric welding soft tissue (EWST), in 98--a standard way. Studied the quality of life of patients using a questionnaire QLQ C30-CR38 and the function of the anal incontinence (Wexner scale). It is established, that the greatest influence on the function of the anal continence have a view of a combined and complex treatment, radicality intervention, the method of forming koloanal of anastomosis. Application EWST the second stage of surgery to cut off excess relegated intestine helped reduce the risk of poor function of the anal continence.

[Combined operative interventions for locally-spread diseases of large bowel].

In the clinic of general surgery, based on The Rural coloproctological centre, in 2012-2013 yrs 469 patients were operated for various diseases of large bowel. There were analyzed the results of treatment in 51 (10.8%) patients, to whom the combined operative interventions (COI) were conducted. For the large bowel tumors 48 (94.1%) patients were operated, for nontumoral diseases--3 (5.9%). COI, as a palliative procedures for the large bowel tumors of various localization, were performed in 22 (13.1%) patients, in 34 (67%)--with resection and excision of one organ, and in 17 (33%)--of two organs and more. In 49 (96%) patients the operation was completed by formation of interintestinal anastomosis or using colonic descendence. In adequate conduction of diagnostic measures and preoperative preparations of patients the COI performance is expedient, because it do not compromise the indices of the patients quality of life. For estimation of the COI risk grade it is necessary to take into account the volume and severity of each stage, expressiveness of the disorders in the organs and systems function as well as the tumors resectability.

[Immediate results of complex treatment of resectable rectal neoplasms of distal localization].

The impact of neoadjuvant chemoradiation on immediate results of treatment of resectable cancer recti, using large-fractionized radiation in combination with endolymphatic chemotherapy, was estimated. Using the method proposed 64 patients were treated (the main group). In control groups there were included 63 patients, to whom a course of a large-fractionized radiation on background of intravenous chemotherapy was applied, and in 91 patients a large-fractionized radiation only was used. The intraoperative complications rate in the main and control groups have had constituted, accordingly, 16, 6.3 and 3.3%. Postoperative complications have had occurred in 12.5% of patients in the main group, and in 15.9% and 14.3% - in the control groups. The abscesses formation was noted in a small pelvis cavity in 4.7% patients of the main, and in 4.8 and 4.4% - in the control groups. Necrosis of the descended gut was revealed in 10 (4.6%).

[Neoadjuvant chemotherapy and radiation therapy of resectable cancer recti of distal localization].

The method of combined neoadjuvant treatment of resectable cancer recti, consisting of preoperative radiaton therapy, using big-fractionized intensive irradiation on the endolymphatic chemotherapy background together with fluorouracil with following surgical intervention (main group), in terms up to 72 h, was elaborated in the clinic. The patients, to whom the chemotherapy and radiation therapy were conducted, were included into control groups. Postoperative complications have had occurred in 8 (12.5%) patients of the main group and in 10 (15.87%) and 13 (14.29%)--in control groups. The five-year survival indices in the main group have constituted (73.5 +/- 6.3)%, and in control groups--(64.6 +/- 5.8) and (64.4 +/- 6.8)%. The local recurrence rate in the main group have constituted (6.2 +/- 3.0)%, and of the remote metastatizing--(15.6 +/- 4.5)%.

[Perspectives of development of the cancer recti surgery].

The immediate and follow-up results of treatment of 2803 patients, operated for cancer recti in The Donetsk Regional Antitumoral Center in 2001-2010 yrs, were analyzed. Complicated course of cancer recti was noted in 17.2% patients. In 1907 (68.0 +/- 1.1)% patients the most frequent operation of abdominoanal resection was done. In 2703 (96.4 +/- 1.6)% patients the primarily restoration of the gut incontinuity operations were performed. Intraoperative complications have had occurred in 259 (9.2 +/- 0.7)% patients, postoperative--in 392 (14.0 +/- 0.6)%, most frequently the descended bowel necrosis--in 136 (4.9)%. The indices of a five-years survival after radical operations have constituted (76.2 +/- 1.7)%, after palliative operations--(10.6 +/- 5.7)%. The surgical doctrine, adopted in the clinic, permit to achieve oncologically effective level of the specialized aid delivery. The results obtained are comparable with such of the main European and Worldwide clinics, what confirms the expediency of surgical trends elaborated.